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DocuSign Envelope ID:87BF107D-405E-4C76-B5D4-6AE86312F5CC <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Barbara Lang Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 905 Cedar Fork Trail City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: $5,000 Purpose: <br /> Wellness Instructor Budget Code(s): 29430320-630000 Vendor#44068 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 7/01/17 <br /> Approved by Board Yes' No Agenda Date: <br /> This agreement is approved as to technical form all content: <br /> r---DocuSigne by: <br /> a� u, 'r� <br /> Department Director's Signature � Date: 7/4/2017 <br /> B7E962D1BF454FA... <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> r---DocuSiggned_by: <br /> Office of the Risk Management Officer aMMS& COVln,f ll b Date: 7/5/2017 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> -- <br /> f —DocuSigned b : <br /> Office of the Chief Financial Officer /5/2017 <br /> �a� �°".�a°'z Date:ate: <br /> -7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> p--DocuSigneed,by�:♦-. <br /> y ate, hark, fibSCb 7/5/2017 <br /> Office of the County Attorney Date: <br /> `—079A4D525C0F4FB... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 2/17 5 <br />